Review of "Autopsy of a Suicidal Mind"

In any other discipline, a
gathering of minds with only half the intellectual prowess and experience of
the consultants brought together in Edwin Shneidman's Autopsy of a Suicidal
Mind would give reason for a celebration. The very nature of suicidology
must make even such a momentous reunion as occurs in this book a somber event.
In Autopsy, Shneidman rejoins forces with seven suicide specialists,
longtime colleague Norman L. Farberow, with whom Shneidman founded the Los
Angeles Suicide Prevention Center (the first center of its kind), and Robert E.
Litman, chief psychiatrist at the LASPC, Avery Weisman, John T. Maltsberger,
David Rudd, Ronald Maris and Morton Silverman, who have share between them
several turns as president of the American Association of Suicidology or editor
of the AAS's journal Suicide and Life-Threatening Behavior, among their
other academic and professional accomplishments. Shneidman himself founded suicidology
as a scientific discipline, and at 86, has spent his entire mature life, the
past fifty years, studying and writing about suicide. This book stands in the
twilight of Shneidman's long life and career, and yet those who are familiar
with Shneidman's work will readily see that his analytic powers as an
interviewer, investigator, and a writer, shine as brightly as ever.

As Shneidman himself admits, Autopsy
is a labor of love. At the conclusion of a talk, which Shneidman rarely gives
nowadays, Hannah Zukin approached Shneidman and, pressing the eleven-page
suicide note of her son Arthur into Shneidman's hands, asked to help her to
understand her son's death. Shneidman impulsively agreed to help, and within
months had conducted interviews with the mother, father, a sister, brother,
pal, ex-wife, girlfriend, psychotherapist, and psychiatrist. These interviews,
along with Arthur's suicide note, he passed along to his colleagues, entreating
them to offer their own views on what happened, why it happened, and whether or
not it could have been prevented. The interviews and analyses comprise Autopsy,
which is a prime specimen of the psychological autopsy—another tool developed
in large part by Shneidman.

Arthur, 33, summed up his
predicament in the first sentence of his suicide note: "All I do is suffer
each & every day." By the time of his death, Arthur had successfully
completed both a law and a medical degree, and was working in medicine. At some
point in his adolescence, he had overcome what was later identified as an
auditory learning disability and change from a temperamental, slow-learning
child, into a hard-working, successful student. By most accounts, Arthur could
do whatever he decided he should do—except, it seems, to conquer the internal
pain which accompanied him for most of his life—a mental pain Shneidman has
conceptualized as "psycheache" (The Suicidal Mind, 1996, Suicide
as Psycheache, ed., 1993). At the young age of seven, Arthur had told a
friend, "One day I'll kill myself," and at fifteen, he made his first
attempt, after returning from a wonderful camp experience. The joy he'd felt at
camp, and the prospect of returning to his usual school days of isolation and
depression were too much for him to deal with—the contrast between joy and pain
too great.

As a small child, Arthur was
susceptible to wild tantrums, which through psychotherapy were eventually
brought under control, although it might be that as Arthur matured, his
emotional sensitivity and violent reactivity were internalized. Competing with
a bright and athletic older brother, Arthur developed perfectionistic
tendencies and a narcissistic view of his own troubles. His parents divorced
when he was eight, and his relationship with his parents is filled with
inconsistency: he treats his mother with much ambivalence—he does not even
mention her in his suicide note— and yet with more respect than his father, who
was also a physician, and met regularly with Arthur in his adult life (although
Arthur claimed to get very little out of these meetings). Nowhere in Autopsy
are the interviewees able to nail down what exactly the effect of the divorce
was on Arthur; nonetheless, it is added to the list of "failures"
which must have weighed heavily on Arthur's sensitive mind.

With both ex-wife and girlfriend,
Arthur established a pattern of catch and release: once he got the girl, he
didn't want her any more, and when he sent her packing, he needed her back. His
psychiatrist suggested that Arthur saw himself as "settling" in both
of these relationships, and not getting what he ideally wanted, and thus in
some sense failing.

As Maltsberger suggests, Arthur
never seemed to be able to accept the flawed nature of human life, that
suffering and imperfection were part and parcel of existence. Litman emphasizes
the narcissistic side of Arthur's character, his sense that there was no other
pain in the world as bad as or of a kind with his own. Despite his many
successes, Arthur's mental anguish and the continual threat of its return in a
major depressive episode shadowed, and eventually eclipsed, his entire life.

Could Arthur have been saved? This
is a central suicidological question, and the majority answer appears to be no.
Although there were many treatment possibilities which Arthur either
discontinued (therapy, medication) or refused (electroconvulsive therapy was
recommended as a possibility by a few of the consultants), it appeared that
Arthur himself had become convinced that no treatment would ultimately 'beat'
his pain. To the possibility of hospitalization, he told his sister that he
knew, as a doctor, how to behave and answer in order to get out. In the end,
Arthur represents a class of humans who, for one reason or another, are
virtually untreatable. And as Ronald Maris points out, even if someone had
saved Arthur by sheer interventionistic force, there arises a disturbing
ethical question about what would justify such insistence on prolonging this
life of suffering.

The success of Autopsy is
certainly not that it provides an unequivocal analysis of Arthur's suicide.
Such is the nature of 170 pages which offers eighteen different perspectives
and hypotheses on the death and intentions of one man—two features of the human
being which for others are virtually opaque. Although many of the interviewees
and analysts emphasize the role biology played in constituting Arthur's
character and his suffering, it remains clear that Arthur was a largely sane
and rational human being—albeit, a human being with much pain inside him. As a
student of philosophy, this reviewer found it remarkable that both the father
and the brother, who both engaged in philosophical conversations with Arthur on
"the meaning of it all" and "the point of things," both
dismissed these dialogues as "abstract exercises." Father and brother
both emphasized biology as the primary cause of Arthur's suffering and suicide,
and thus excused his existential pessimism as symptomatic. Here was a man
actively searching for a "meaning" which would give his pain sense. Then,
perhaps, he could have better tolerated it. But it seems that Arthur concluded
of his pain essentially the same as his father and brother concluded of their
philosophical conversations with him—that, at bottom, it was all senseless, and
thus, for Arthur, not worth living out.

What Autopsy teaches the
reader is that suicide is the most slippery of topics. When not even the sagest
professionals in the field can voice a harmonious explanation, or give a
unanimously hopeful analysis, the student and the survivor will be reminded
that suicide is a wellspring of confusion and complexity—not only emotionally,
but intellectually, too. In cases such as Arthur's, where the interviewees are
themselves impressively educated and articulate (all his family members hold
advanced degrees), the psychological autopsy begins to reveal that each suicide
is in many ways as nuanced, distinct, and original as those individuals who
engage in the act. The diagnostic categories often help to map the general
terrain of suicide, but they rarely provide the comfort, assurance, or clarity
desired by those desperately seeking to discover what has gone wrong. For that,
we have to defer to magnanimous human beings such as Edwin Shneidman, who will
invest all the powers at his disposal to find something to say by way of
comfort and explanation to the survivors, and who in some ways transcends his
role as a scientist to put together this scrapbook of Arthur's life as a gift
to his mother and the others. It is as thick with intrigue, discrepancy,
discovery, and contradiction, as the troubled life which it examines. The
ultimate question, Why?, is at once the most obvious and the most
obscure of all the questions asked of not only Arthur's, but of any suicide.

Matthew Pianalto is a Ph.D. student
in philosophy at the University of Arkansas, where he has also taught logic and
introduction to philosophy. He holds a B.A. in English, and an M.A. in
Philosophy. His master's thesis, "Suicide & The Self," attempts
to reinvest in the philosophical nature of the problem of suicide. More info at
his website: http://comp.uark.edu/~mpianal.
(See "Suicide & Philosophy" link for resources on suicide.)